FFP Transfusion in Dengue Fever

Indications for FFP Transfusion

The American College of Physicians and other medical societies recommend that FFP should NOT be routinely used in dengue fever, even in the presence of thrombocytopenia or coagulopathy, unless there is active significant bleeding with documented coagulation abnormalities (PT >1.5 times normal, INR >2.0, or aPTT >2 times normal) 1
FFP transfusion is appropriate in cases of active bleeding with coagulopathy, where there is excessive microvascular bleeding AND documented coagulation abnormalities with PT >1.5 times normal, INR >2.0, or aPTT >2 times normal 1, 2
In cases of massive hemorrhage due to dengue hemorrhagic fever, FFP may be indicated for significant ongoing bleeding and coagulation factor deficiency 3, 4
FFP may also be used in cases of disseminated intravascular coagulation (DIC) with laboratory evidence showing prolonged PT/aPTT beyond dilution, thrombocytopenia, and fibrinogen <1.0 g/L with active bleeding 3

The standard dose of FFP is 10-15 ml/kg body weight to achieve a minimum 30% plasma factor concentration 1, 5
This translates to approximately 2-4 units (500-1000 ml) for a 70 kg adult 5
FFP must be ABO compatible with the recipient 1, 5

FFP should NOT be used to correct coagulation test abnormalities in non-bleeding patients 1, 6
FFP is not indicated for isolated thrombocytopenia without coagulopathy and bleeding 1
FFP should never be used as a plasma volume expander or for albumin replacement 1, 5

For isolated hypofibrinogenemia (<1.0 g/L), cryoprecipitate or fibrinogen concentrate is more effective than FFP 2, 3
Fibrinogen replacement with cryoprecipitate is preferred over FFP if fibrinogen <1.0 g/L with bleeding 2, 3